As COVID-19 Spreads, It's Time to Diagnose & Treat Our Broken PHC Systems

As the explosive impact of COVID-19 ripples globally, there’s a clear plea from many regions and countries: stay home and help “flatten the curve” of infection. People from China to Italy have seen the consequences of the virus spreading too quickly with hospitals overwhelmed and doctors forced to make heartbreaking decisions about who lives and dies.

It’s natural to hear these stories and blame a lack of pandemic preparedness. But emergency response can only go so far if the health system’s first line of defense – primary health care – isn’t up to the task.

Experts have already called attention to gaps in front line health supplies, such as masks, hand sanitizer, testing kits and vaccines. In the U.S., where we live, these gaps mean we’re now fighting a steep uphill battle in containing the virus. But few are talking about shortcomings of the primary health care system, which is about far more than just supplies. Strong primary health care looks like a trusted nurse or doctor, who is always there and trained to answer your questions. It means comprehensive quality care – in one place – tailored to your health needs. It means confidence that your local health center is safe and ready with quality medicines and supplies, regardless of outbreaks or changes in the world around you.

Whether or not a crisis is looming, primary health care should be the first place everyone turns for health services or information, using hospitals only when truly necessary.

For most people worldwide, though, access to quality primary health care depends on where you live or how much money you have. In fact, primary health care is chronically underfunded and deprioritized in rich and poor countries alike.

COVID-19 has made it painfully clear that we can’t afford to have weak primary health care continue as our reality. In the U.S., fragmented care and lack of clear communication from experts has left people anxious about where to turn, making unnecessary visits to emergency rooms. In Italy, where the health care system has experienced cuts in funding over the past decade, we’re seeing the dire consequences of having too few staff and supplies. And across Africa, where the virus is rapidly spreading, misinformation and mistrust of health systems could keep people from seeking care – as we saw in Liberia and other West African countries during the 2014-2016 Ebola outbreak.

This doesn’t have to be the case. There are clear steps the world can take to fully unlock the potential of primary health care, both to help us respond to the current pandemic and prepare for disease outbreaks we’ll inevitably face in the future.

In the short-term, primary care providers should be considered central partners and first responders in this crisis, helping to test and triage the most at-risk patients, and reducing the burden on already-overwhelmed hospitals. Leaders owe them reliable information and tools, including additional support for logistics and staffing and critical supplies such as rapid test kits and personal protective equipment. Such approaches have paid off in a big way in countries like Singapore, where they’ve been able to mobilize a trusted and well-resourced primary health care workforce.

Trusted primary care providers can also play a key role disseminating prevention messages to the public and high-risk groups, and encouraging social distancing by offering telehealth services for people with COVID-19 symptoms and chronic disease patients alike.

In the weeks and months ahead, countries and donors should also resist the urge to earmark all response funds for coronavirus-specific care. As health systems approach breaking point, flexible funds for primary health care can aid the response and prevent disruptions to essential daily life-saving services, from delivering babies to treating chronic conditions. This approach will also help head off future epidemics, rather than promote a continuous cycle of “Band-Aid” investments that ignore the root of the problem.

In the long term, governments must significantly increase spending on quality primary health care to make sure it’s well-resourced and affordable – so that no one has to choose between seeking care and paying their bills. The World Health Organization estimates that it will take an additional $200 billion annually to fund quality primary health care for all; well-spent, this could save 60 million lives in low- and middle-income countries alone.

Finally, we can’t fix problems that we can’t diagnose. Countries desperately need better ways to take the temperature of their primary health care systems. At the Primary Health Care Performance Initiative, a partnership of country policymakers, health systems managers and advocates, we’re working with governments around the world to collect more and better data, equipping leaders to pinpoint weaknesses and improve health systems before the next pandemic hits. Counting treatments or people infected is not enough – we need to know if people trust and value their care; if health workers are trained, resourced and motivated; and if clinics are safe, clean and well-managed.

We are only as prepared as the world’s weakest health system. The world has repeatedly failed to learn this before. We must do better beginning today, or this won’t be the last time we pay the price.

This piece was originally published in Health Policy Watch on March 24, 2020.